Recommended immunization schedule for children age 0 through 6 years – United States, 2024 (for those who fall behind or start late, refer to UpToDate content related to the catch-up schedule)

anti-HBs: hepatitis B surface antibody; COVID-19: coronavirus disease 2019; HBeAg: hepatitis B e antigen; HBIG: hepatitis B immune globulin; HBsAg: hepatitis B surface antigen; IIV4: quadrivalent inactivated influenza vaccine; LAIV4: quadrivalent live attenuated influenza vaccine; MenACWY-CRM: Menveo; MenACWY-TT: MenQuadfi; mIU: milli-international units; MMRV: combined measles, mumps, rubella, and varicella vaccine; PCV13: 13-valent pneumococcal conjugate vaccine; PCV15: 15-valent pneumococcal conjugate vaccine; PCV20: 20-valent pneumococcal conjugate vaccine; RSV: respiratory syncytial virus.

* School entry age group.

¶ Respiratory syncytial virus vaccination (RSV-mAb [nirsevimab])

• Infants born October through March in most of the continental United States
  • Mother did not receive RSV vaccine or mother's RSV vaccination status is unknown: Administer 1 dose nirsevimab within 1 week of birth (before discharge or in outpatient setting).
  • Mother received RSV vaccine <14 days prior to delivery: Administer 1 dose nirsevimab within 1 week of birth (before discharge or in outpatient setting).
  • Mother received RSV vaccine at least 14 days prior to delivery: Nirsevimab not needed. Refer to UpToDate content for rare circumstances when nirsevimab can be considered.
• Infants born April through September in most of the continental United States
  • Mother did not receive RSV vaccine or mother's RSV vaccination status is unknown: Administer 1 dose nirsevimab shortly before start of RSV season.
  • Mother received RSV vaccine less than 14 days prior to delivery: Administer 1 dose nirsevimab shortly before start of RSV season.
  • Mother received RSV vaccine at least 14 days prior to delivery: Nirsevimab not needed. Refer to UpToDate content for rare circumstances when nirsevimab can be considered.
• Special situations
  • Age 8 through 19 months and at risk for severe RSV disease: 1 dose nirsevimab shortly before start of second RSV season. High-risk conditions include:
    • Children with chronic lung disease of prematurity who required medical support at any time during the six-month period before the start of the RSV season.
    • Children who are severely immunocompromised.
    • Children with cystic fibrosis who have manifestations of severe lung disease or have weight-for-length that is <10^th percentile.
    • American Indian and Alaska Native children.
  • Age-eligible and undergoing cardiac surgery with cardiopulmonary bypass: 1 additional dose of nirsevimab after surgery. For additional details see special populations and situations at http://www.cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html

Infants with prolonged birth hospitalization (eg, for prematurity) discharged October through March should be immunized shortly or promptly after discharge.

Refer to UpToDate content for additional details.

Δ Hepatitis B (HepB) vaccination

• Routine vaccination:
  • 3-dose series at age 0, 1 through 2, and 6 through 18 months (use monovalent HepB vaccine for doses administered before age 6 weeks).
    • Birth weight ≥2 kg: 1 dose within 24 hours of birth if medically stable.
    • Birth weight <2 kg: 1 dose at chronological age 1 month or hospital discharge (whichever is earlier and even if weight is still <2 kg).
  • Infants who did not receive a birth dose should begin the series as soon as possible. Refer to UpToDate content related to the catch-up immunization schedule.
  • Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.
  • Final (third or fourth) dose: Age 6 through 18 months (minimum age 24 weeks).
• Mother is HBsAg-positive:
  • Birth dose (monovalent HepB vaccine only): Administer HepB vaccine and HBIG (in separate limbs) within 12 hours of birth, regardless of birth weight.
  • Birth weight <2 kg: Administer 3 additional doses of HepB vaccine beginning at age 1 month (total of 4 doses).
  • Final (third or fourth dose): Administer at age 6 months (minimum age 24 weeks).
  • Test for HBsAg and anti-HBs at age 9 through 12 months. If HepB series is delayed, test 1 to 2 months after final dose. Do not test before age 9 months.
• Mother is HBsAg-unknown: If other evidence suggestive of maternal hepatitis B infection exists (eg, presence of HBV DNA, HBeAg-positive, or mother known to have chronic hepatitis B infection), manage infant as if mother is HBsAg-positive.
  • Birth dose (monovalent HepB vaccine only):
    • Birth weight ≥2 kg: Administer HepB vaccine within 12 hours of birth. Determine mother's HBsAg status as soon as possible. If mother is determined to be HBsAg-positive, administer HBIG as soon as possible (in separate limb), but no later than 7 days of age.
    • Birth weight <2 kg: Administer HepB vaccine and HBIG (in separate limbs) within 12 hours of birth. Administer 3 additional doses of HepB vaccine beginning at age 1 month (total of 4 doses).
  • Final (third or fourth) dose: Administer at age 6 months (minimum age 24 weeks).
  • If mother is determined to be HBsAg-positive or if status remains unknown, test for HBsAg and anti-HBs at age 9 through 12 months. If HepB series is delayed, test 1 to 2 months after final dose. Do not test before age 9 months.
• Special situations:
  • Revaccination is not generally recommended for persons with a normal immune status who were vaccinated as infants, children, adolescents, or adults.
  • Postvaccination serology testing and revaccination (if anti-HBs <10 mIU/mL) is recommended for certain populations, including:
    • Infants born to HBsAg-positive mothers.
    • Persons who are predialysis or on maintenance dialysis.
    • Other immunocompromised persons.
  • For detailed revaccination recommendations, refer to www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepb.html.

◊ Rotavirus (RV) vaccination

• RV1 (Rotarix): 2-dose series at age 2 and 4 months.
• RV5 (RotaTeq): 3-dose series at age 2, 4, and 6 months.
• If any dose in the series is either RV5 or unknown, default to 3-dose series.

§ Diphtheria and tetanus toxoids, and acellular pertussis (DTaP) vaccination

• Routine: Five-dose series (3-dose primary series at age 2, 4, and 6 months, followed by booster doses at 15 through 18 months and 4 through 6 years).
• Prospectively: Dose 4 may be administered as early as age 12 months if at least 6 months have elapsed since dose 3.
• Retrospectively: A fourth dose that was inadvertently administered as early as 12 months may be counted if at least 4 months have elapsed since dose 3.
• Wound management: See www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm for DTaP vaccination indications as part of wound management.

¥ Haemophilus influenzae type b (Hib) vaccination

• Routine vaccination:
  • ActHIB, Hiberix, Pentacel, or Vaxelis: 4-dose series (3-dose primary series at age 2, 4, and 6 months, followed by a booster dose at age 12 through 15 months). Vaxelis is not recommended for use as a booster dose. A different Hib-containing vaccine should be used for the booster dose.
  • PedvaxHIB: 3-dose series (2-dose primary series at age 2 and 4 months, followed by a booster dose at age 12 through 15 months).
• Special situations:
  • Refer to UpToDate content related to Hib vaccination and immunization in the specific high-risk group and the ACIP recommendations. Special situations and high-risk groups include chemotherapy or radiation treatment, hematopoietic cell transplant, anatomic or functional asplenia (including sickle cell disease), elective splenectomy, HIV infection, immunoglobulin deficiency, and early complement component deficiency.

‡ Pneumococcal vaccination

• Routine vaccination with PCV:
  • Four-dose series at age 2, 4, 6, and 12 through 15 months.
• NOTE: PCV15 and PCV20 can be used interchangeably for children who are healthy or have underlying conditions. If the infant received PCV13 for the initial doses, the series may be completed with PCV15 or PCV20; restarting the series is not necessary.
• Special situations:
  • High-risk conditions: Refer to separate UpToDate content and the ACIP recommendations for information on pneumococcal vaccination in children with high-risk conditions. High-risk conditions include functional or anatomic asplenia (eg, sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia or splenic dysfunction); congenital or acquired immunodeficiencies; HIV infection; nephrotic syndrome; chronic kidney disease; on maintenance dialysis; malignant neoplasms, leukemias, lymphomas, Hodgkin disease, multiple myeloma, and other diseases treated with chemotherapy and/or radiation therapy; iatrogenic immunosuppression (eg, solid organ transplantation, long-term systemic glucocorticoids, tumor necrosis alpha inhibitors [eg, etanercept, infliximab], radiation therapy); cerebrospinal fluid leak; cochlear implant; chronic heart disease (particularly cyanotic congenital heart disease, cardiac failure, and cardiomyopathy); chronic lung disease (including moderate-to-severe persistent asthma); diabetes mellitus; and chronic liver disease.
  • Children with high-risk conditions should receive at least one dose of PCV20 or PPSV23.
  • When both PCV15 and PPSV23 are indicated, administer PCV15 first. PCV15 and PPSV23 should not be administered during the same visit.

† Inactivated poliovirus (IPV) vaccination

• 4-dose series at age 2, 4, and 6 through 18 months, and 4 through 6 years; administer the final dose on or after age 4 years and at least 6 months after the previous dose.
• 4 or more doses of IPV can be administered before age 4 years when a combination vaccine containing IPV is used. However, a dose is still recommended at or after age 4 years and at least 6 months after the previous dose.

** COVID-19 vaccination

• Age 6 months through 4 years:
  • Unvaccinated: 2-dose series of updated (2023-2024 formula) Moderna at 0 and 4 through 8 weeks or 3-dose series at 0, 3 through 8, and 11 through 16 weeks of updated (2023-2024 formula) Pfizer-BioNTech.
  • Previously vaccinated with:
    • 1 dose of Moderna: 1 dose of updated (2023-2024 formula) Moderna 4 to 8 weeks after most recent dose.
    • 2 or more doses of Moderna: 1 dose of updated (2023-2024 formula) Moderna at least 8 weeks after most recent dose.
    • 1 dose of Pfizer-BioNTech: 2-dose series of updated (2023-2024 formula) Pfizer-BioNTech at 0 and 8 weeks (minimum interval between previous dose and dose 1: 3 through 8 weeks).
    • 2 or more doses of Pfizer-BioNTech: 1 dose of updated (2023-2024 Formula) Pfizer-BioNTech at least 8 weeks after most recent dose.
• Age 5 through 6 years:
  • Unvaccinated: 1 dose of updated (2023-2024 formula) Moderna or Pfizer-BioNTech vaccine.
  • Previously vaccinated with 1 or more doses of Moderna or Pfizer-BioNTech: 1 dose of updated (2023-2024 formula) Moderna or Pfizer-BioNTech at least 8 weeks after the most recent dose.
• Moderately or severely immunocompromised:
  • Unvaccinated:
    • Age 6 months through 4 years: 3-dose series at 0, 4, and 8 weeks of updated (2023-2024 formula) Moderna or 3-dose series at 0, 3, and 11 weeks of updated (2023-2024 formula) Pfizer-BioNTech.
    • Age 5 through 6 years: 3-dose series at 0, 4, and 8 weeks of updated (2023-2024 formula) Moderna or 3-dose series at 0, 3, and 7 weeks of updated (2023-2024 formula) Pfizer-BioNTech.
  • Ages 6 months through 4 years and previously vaccinated with:
    • 1 dose of Moderna: 2-dose series of updated (2023-2024 formula) Moderna at 0 and 4 weeks (minimum interval between previous dose and dose 1: 4 weeks).
    • 2 doses of Moderna: 1 dose of updated (2023-2024 formula) Moderna at least 4 weeks after most recent dose.
    • 3 or more doses of Moderna: 1 dose of updated (2023-2024 formula) Moderna at least 8 weeks after most recent dose.
    • 1 dose of Pfizer-BioNTech: 2-dose series of updated (2023-2024 formula) Pfizer-BioNTech at 0 and 8 weeks (minimum interval between previous dose and dose 1: 3 weeks).
    • 2 or more doses of Pfizer-BioNTech: 1 dose of updated (2023–2024 formula) Pfizer-BioNTech at least 8 weeks after the most recent dose.
  • Ages 5 through 6 years and previously vaccinated with:
    • 1 dose of Moderna: 2-dose series of updated (2023-2024 formula) Moderna at 0 and 4 weeks (minimum interval between previous dose and dose 1: 4 weeks).
    • 2 doses of Moderna: 1 dose of updated (2023-2024 formula) Moderna at least 4 weeks after most recent dose.
    • 1 dose of Pfizer-BioNTech: 2-dose series of updated (2023-2024 formula) Pfizer-BioNTech at 0 and 4 weeks (minimum interval between previous dose and dose 1: 3 weeks).
    • 2 doses of Pfizer-BioNTech: 1 dose of updated (2023-2024 formula) Pfizer-BioNTech at least 4 weeks after the most recent dose.
    • 3 or more doses of any Moderna or Pfizer-BioNTech: 1 dose of updated (2023-2024 formula) Moderna or Pfizer-BioNTech at least 8 weeks after the most recent dose.

• NOTE: Administer an age-appropriate vaccine product for each dose. Current COVID-19 schedule and dosage formulation available at www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html. For more information on Emergency Use Authorization (EUA) indications for COVID-19 vaccines, refer to www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines.

¶¶ Influenza vaccination

• Use any influenza vaccine appropriate for age and health status annually (refer to UpToDate content related to influenza vaccination in children and the ACIP recommendations):
  • 2 doses separated by at least 4 weeks for children age 6 months through 8 years who have received fewer than 2 influenza vaccine doses before July 1, 2023, or whose influenza vaccination history is unknown (administer dose 2 even if the child turns 9 between receipt of dose 1 and dose 2).
  • 1 dose for children age 6 months through 8 years who have received at least 2 influenza vaccine doses before July 1, 2023.
• For the 2023-2024 season, refer to the 2023-2024 ACIP influenza vaccine recommendations.
• For the 2024-2025 season, refer to the 2024-2025 ACIP influenza vaccine recommendations.

ΔΔ Measles, mumps, and rubella (MMR) vaccination

• Routine vaccination:
  • 2-dose series at age 12 through 15 months and age 4 through 6 years.
  • MMR or MMRV may be administered. For dose 1 in children age 12 through 47 months, it is recommended to administer MMR and varicella vaccines separately. MMRV may be used if parents or caregivers express a preference.
• International travel:
  • Infants age 6 through 11 months: 1 dose before departure; revaccinate with 2-dose series at age 12 through 15 months (12 months for children in high-risk areas) and dose 2 as early as 4 weeks later.
  • Unvaccinated children age 12 months or older: 2 doses at least 4 weeks apart before departure.

◊◊ Varicella (VAR) vaccination

• 2-dose series at 12 through 15 months and 4 through 6 years.
• VAR or MMRV may be administered. For dose 1 in children age 12 through 47 months, it is recommended to administer MMR and varicella vaccines separately. MMRV may be used if parents or caregivers express a preference.
• Dose 2 may be administered as early as 3 months after dose 1 (a dose inadvertently administered after a 4-week interval may be counted as valid).

§§ Hepatitis A (HepA) vaccination

• Routine vaccination:
  • 2-dose series (minimum interval: 6 months) at age 12 through 23 months.
• International travel:
  • Persons traveling to countries with high or intermediate endemic hepatitis A (refer to wwwnc.cdc.gov/travel):
    • Infants age 6 through 11 months: 1 dose before departure; revaccinate with 2 doses, separated by at least 6 months, between age 12 and 23 months.
    • Unvaccinated age 12 months or older: Administer dose 1 as soon as travel is considered.

¥¥ Meningococcal serogroup A, C, W, Y (MenACWY) vaccination

• Special situations:
  • Refer to UpToDate content related to meningococcal vaccines and immunization in specific high-risk groups. High-risk groups include anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (eg, eculizumab, ravulizumab) use, and travel in countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj (refer to wwwnc.cdc.gov/travel).
  • MenACWY-CRM (Menveo) has two formulations: lyophilized and liquid. The liquid formulation should not be used before age 10 years.